E-132 Successful mechanical thrombectomy in an 11-year-old patient with emergent large vessel occlusion acute ischemic stroke related to congenital complete heart block and recent covid-19 infection
Notice bibliographique
Résumé
Objective Case report of a pediatric acute ischemic stroke with left M1 middle cerebral artery occlusion with large penumbra who underwent mechanical thrombectomy with TICI 3 reperfusion. Case An 11-year-old pediatric male patient with a history of congenital complete heart block presented to our hospital 30 minutes after the sudden onset of right sided weakness and aphasia. The patient was diagnosed with COVID-19 infection about 2 weeks before the stroke after presenting with upper respiratory tract infection symptoms, fatigue, cough, and muscle aches. On neurological examination, the patient was alert with expressive aphasia, left-sided partial gaze preference, right-sided upper motor neuron type facial weakness, right sided motor weakness in upper and lower extremity 2/5. The initial National Institute of Health Stroke Scale (NIHSS) score was 16. The computed tomography (CT) of the head revealed left middle cerebral artery (MCA) territory ischemia in the basal ganglia region (Alberta Stroke Program Early CT Score - 9) with no acute intracranial hemorrhage or mass effect. CT angiography demonstrated an occlusion of left M1 segment of the MCA. CT Perfusion imaging was suggestive of a large ischemic penumbra. Neuroendovascular service was consulted and candidacy for interventional treatment was confirmed. Procedure The patient underwent endovascular thrombectomy under general anesthesia. The patient was placed on the angiographic table and the right femoral access was obtained using a micropuncture kit with a 19-gauge Seldinger needle. A short 6 French sheath (Terumo) was placed. The short sheath was exchanged for a 90 cm Neuronmax long sheath and advanced over a 5 French catheter (Penumbra Select) over a 0.035 inch GlidewireTM (Terumo) and placed at the cervical segment of the left internal carotid artery. The initial diagnostic angiogram revealed a complete occlusion of the left middle cerebral artery at the M1 segment. The guiding catheter was then advanced into the cervical segment of the left internal carotid artery, and a RED 72 aspiration catheter was advanced over a Velocity microcatheter to the proximal end of the thrombus. We successfully approximated the aspiration catheter to the proximal end of the thrombus and started the aspiration. Aspiration was continued for one minute before slowly withdrawing the catheter until free blood flow was achieved. Examination showed the removal of a large piece of thrombus, but control angiography after the first pass revealed that the left M1 MCA remained occluded. The same technique was repeated for a second pass using the RED 72 aspiration catheter, and the subsequent control left ICA angiography demonstrated TICI 3 reperfusion and patency of all branches of the left internal carotid artery. The patient was transferred to the pediatric ICU for post-thrombectomy care and stroke evaluation. Neurological examination post-thrombectomy revealed significant improvement with an NIHSS score of 2 on day 1 after the procedure. The patient was started on aspirin 81 mg for secondary stroke prophylaxis. Conclusions This is a first known report of a successful mechanical thrombectomy in a pediatric patient due to a large vessel occlusion related to congenital complete heart block and recent COVID-19 infection. Disclosures J. Ansari: None. D. Mata Canadas: None. M. Ayub: None. J. Caskey: None. P. Simoncini: None. R. Riel-Romero: None. P. Sharma: None. D. Jordan: None. H. Cuellar: None.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,000 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,003 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».